Dit artikel is eerder gepubliccerd in het Nederlands Vlaams Tijdschrift voor Palliatieve Zorg, 2020-16 https://nvtpz.org/ Samenvatting (Nederlands) Het kwaliteitskader Palliatieve zorg beschrijft als standaard: Proactieve zorgplanning wordt tijdig en op passende wijze aan de orde gesteld, bij voorkeur door de hoofdbehandelaar of centrale zorgverlener of door de patiënt en diens naasten. Voor het palliatief adviesteam van een thuiszorgorganisatie in het oosten van Nederland is in drie deelonderzoeken onderzocht hoe verzorgenden en verpleegkundigen (V&V) proactieve zorgplanning in de praktijk vormgeven. In de deelonderzoeken zijn diverse onderzoeksmethoden toegepast: interviews, vragenlijsten en focusgroepen. In totaal hebben 238 V&V deelgenomen: 4 in interviews, 185 door het invullen van een vragenlijst en 49 in focusgroepen. Uit de resultaten blijkt dat V&V afwachtend zijn in het aangaan van gesprekken over wensen en behoeften. Dit gesprek wordt niet structureel gepland bij zorgvragers die in aanmerking komen voor een palliatieve zorgbenadering. Voornamelijk hbo2 -verpleegkundigen spreken vroegtijdig over het lijden (59%) en overlijden (55%) in de toekomst. Mbo3 -verzorgenden niveau 3 stellen deze onderwerpen het minst aan de orde, resp. 11% en 9%. V&V maken tot op heden geen gebruik van gesprekstools, maar alle drie de geselecteerde gesprekshulpen 1) Gesprekswijzer Proactieve zorgplanning, 2) Flowchart en 3) Wensenboekje lijken als set implementeerbaar in de thuiszorgorganisatie. Samenvatting (Engels)2 The quality framework Palliative care describes as standard: Proactive care planning is addressed in a timely and appropriate manner, preferably by the main professional or central care provider or by the patient and his relatives. For the palliative advisory team of a home care organization in the east of the Netherlands, three sub-studies investigated how nurses and certified nurses perform proactive care planning in practice. Various research methods were applied in the sub-studies: interviews, questionnaires and focus groups. A total of 238 nurses and certified nurses participated: 4 in interviews, 185 in a questionnaire and 49 in focus groups. The results show that (certified) nurses are cautious when entering into discussions about wishes and needs. These discussions are not structurally planned by all care recipients who are eligible for a palliative care approach. Especially, bachelor nurses speak early about the suffering (59%) and death (55%) in the future, whereas certified nurses level 3 addressing these subjects the least, resp. 11% and 9%. Up to now, (certified) nurses do not use conversation aids. All three selected conversation aids by this care organization 1) Conversation guide Proactive care planning, 2) Flowchart and 3) Wish booklet seem to be able to implement as a set
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Het generalist-plus-specialistische palliatieve zorgmodel wordt wereldwijd onderschreven. In Nederland zijn de competenties en het profiel van de generalistische aanbieder van palliatieve zorg beschreven op alle professionele niveaus in de verpleegkunde en geneeskunde.
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BackgroundHospital admissions are common in the last phase of life. However, palliative care and advance care planning (ACP) are provided late or not at all during hospital admission.AimTo provide insight into the perceptions of in-hospital healthcare professionals concerning current and ideal practice and roles of in-hospital palliative care and advance care planning.MethodsAn electronic cross-sectional survey was send 398 in-hospital healthcare professionals in five hospitals in the Netherlands. The survey contained 48 items on perceptions of palliative care and ACP.ResultsWe included non-specialists who completed the questions of interest, resulting in analysis of 96 questionnaires. Most respondents were nurses (74%). We found that current practice for initiating palliative care and ACP was different to what is considered ideal practice. Ideally, ACP should be initiated for almost every patient for whom no treatment options are available (96.2%), and in case of progression and severe symptoms (94.2%). The largest differences between current and ideal practice were found for patients with functional decline (Current 15.2% versus Ideal 78.5%), and patients with an estimated life expectancy <1 year (Current 32.6% versus ideal 86.1%). Respondents noted that providing palliative care requires collaboration, however, especially nurses noted barriers like a lack of inter-professional consensus.ConclusionsThe differences between current and ideal practice demonstrate that healthcare professionals are willing to improve palliative care. To do this, nurses need to increase their voice, a shared vision of palliative care and recognition of the added value of working together is needed.
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